Endoscopic Versus Microscopic Approach in Stapes Surgery: Are Operative Times and Learning Curve Important for Making the Choice?

OBJECTIVE

Analyze the surgical outcomes of endoscopic stapes surgery, comparing the results with a conventional stapes surgery under microscopic approach. Estimate the operation type of each surgical approach and show a learning curve of endoscopic stapes surgery.

STUDY

DESIGN

Retrospective study.

SETTING

Tertiary referral center.

PATIENTS: Twenty patients who underwent endoscopic stapedotomy for otosclerosis and 20 patients who underwent microscopic stapedotomy for otosclerosis.

INTERVENTIONS: Endoscopic and microscopic stapes surgery.

MAIN OUTCOME MEASURES: Operating time, preoperative and postoperative hearing, intraoperative findings, postoperative complications, and postoperative pain.

RESULTS

The group of patients who underwent endoscopic stapes surgery showed a mean operative time calculated to be 45.0 min. The group of patients treated by microscopic approach had an estimated mean value of 36.5 min. Statistical difference was evident (p value = 0.01). The average duration of endoscopic surgery varied as the surgeon gained experience. There were no statistical differences between the average surgical times for the endoscopic and microscopic approaches (p >0.05) in the last 4-month period of surgery. Through the endoscopic approach the percentage of ears with a postoperative air-bone gap ≤20 dB was 95%. No difference from the percentage of the microscopic group (90%) (p >0.05) was reported. No difference regarding the incidence of intraoperative findings and postoperative complications between endoscopic and microscopic approaches was found.

CONCLUSION

Audiological outcomes achieved by endoscopic surgery are similar to the results obtained through a microscopic approach. Longer initial operative times and a learning curve are the principal grounds that might discourage most ear-surgeons from commencing endoscopic stapes surgery.